MEDICARE: DR. MATTHEW RAPHAEL SNYDER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS0000005245	TN

General Provider Information

NPI Number	:	1972583920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW RAPHAEL SNYDER D.D.S.

Provider Business Mailing Address
First Line	:	743 MEADOWVIEW CT
Second Line	:
City	:	ELIZABETHTON
State	:	TN
Zip	:	37643-5063
Country	:	US
Telephone Number	:	423-543-1677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 VOLUNTEER PKWY
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-4658
Country	:	US
Telephone Number	:	423-764-4166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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